The role of Movat pentachrome stain and immunoglobulin G4 immunostaining in the diagnosis of autoimmune pancreatitis

Abstract

Autoimmune pancreatitis is highly responsive to steroid therapy, but because it mimics pancreatic cancer, it often precipitates unnecessary surgery. Adequate diagnostic tests are needed to permit appropriate medical therapy. Lymphocytic and obliterative phlebitis are reported in the majority of cases, as are elevated IgG4-positive plasma cells, indicating their high sensitivity. Their specificities, especially when used in conjunction, however, remain largely unknown. Movat pentachrome vascular and IgG4 immunohistochemical stains were performed on a total of 15 autoimmune pancreatitis cases (11 pancreatic resections and 4 biopsies), 39 usualtype alcoholic or idiopathic chronic pancreatitis cases, 35 pancreatic ductal adenocarcinoma-associated chronic pancreatitis cases, and 29 normal pancreata. Marked and diffuse lymphocytic and obliterative venulitis were detected in all 15 cases of autoimmune pancreatitis on Movat staining (100% sensitivity). Only a single carcinoma-associated chronic pancreatitis case among all of the controls showed diffuse benign venulitis that was nonobliterative (99% specificity). Nine of 13, 9 autoimmune pancreatitis cases showed marked IgG4 immunopositivity at X10 positive plasma cells per  400 field (69% sensitivity). No increased IgG4 plasma cells were found in any of 103 controls (100% specificity). In combination, all of the autoimmune pancreatitis cases had at least one (13/13) and most had both markers (9/13), whereas none of the controls had both markers. Overall, these combined stains show very promising diagnostic utility and should be considered in combination with clinical and serologic analyses in the evaluation of chronic pancreatitis suspicious for malignancy. Future validating studies on preoperative biopsies with outcome data following steroid therapy will be essential.

Utility of a 21-gauge Menghini-type biopsy needle with the rolling method for an endoscopic ultrasound-guided histological diagnosis of autoimmune pancreatitis: a retrospective study

“…A previous report comparing pancreatic biopsy specimens and surgically resected specimens showed that pancreatic specimens by core biopsy provided adequate histologic findings for AIP in only 22% of cases (2/9), whereas surgical specimens almost always provided sufficient findings for making a diagnosis [34]. In addition, the patchy distribution of specific histological findings, such as LPSP [35][36][37] and infiltration of IgG4-positive plasma cells [38] and the different severities [34] can affect the detection rate of histological findings. These data indicate that 22-gauge Fig.…”

Utility of the Movat pentachrome stain technique in the microanatomical analysis of the human placenta

“…The expression of the studied markers was evaluated independently by two independent observers (ZD, JD) using the Leica LD 5000HL light microscope. Identification of tissue types was based on colour evaluation of stained tissues derived from the available literature (Chu et al 2009;Felföldi et al 2021;Kajbafzadeh et al 2017;Willershausen et al 2019), Due to the small size of the material, statistical analysis was omitted and the results were presented as observational data.…”

Idiopathic Duct Centric Pancreatitis in Korea: A Clinicopathological Study of 14 Cases

“…Immunochemical staining for IgG4 (monoclonal anti-mouse IgG4 antibody, Binding Site, Birmingham, UK) was conducted with 4 μm-thick paraffin embedded tissue sections, as described previously. 15 Briefly, antigen was retrieved by heating the tissue sections in pH 6.0 citrate buffer. Tissue sections were then incubated with primary anti-mouse IgG4 (1 : 400) for 37 minutes at 37°C.…”